You will be held Accountable for providing medical management and clinical oversight to insured members in compliance with Client policies to ensure maximum quality of care and cost containment.
A Typical Day Could Include :
Evaluating, insuring eligibility status and benefits, while providing pre-certification authorization as required.
Full Case Management.
Liaison between the Medical and Non-medical Case Management, Assistance, and Claims teams
Operating as the liaison between the patient / family members, the client and the provider(s).
Reviewing medical facts to determine if the treatment is medically approved per client policy and is the most cost effective while maintaining quality of care.
Providing clinical assessments
Coordinating patient care and medical treatment by directing patients to appropriate network facilities.
We require the below Skill Sets :
Fluent in English and Italian (Written and Spoken)
Minimum of 3 years of clinical nursing experience preferably from an emergency or acute care setting
Availability to work rotating shifts.
Registered Nursing Diploma
Current BLS certification
Experience in Travel or Major Medical Insurance industry an asset.
Experience with non-Canadian medical system an asset.